| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer with compression |
427 |
392 |
$20K |
| E0601 |
Cont airway pressure device |
79 |
67 |
$3K |
| A6216 |
Non-sterile gauze<=16 sq in |
390 |
343 |
$2K |
| A6196 |
Alginate dressing <=16 sq in |
27 |
22 |
$2K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
44 |
32 |
$1K |
| A6212 |
Foam drg <=16 sq in w/border |
14 |
13 |
$1K |
| A6266 |
Impreg gauze no h20/sal/yard |
17 |
13 |
$1K |
| A6260 |
Wound cleanser any type/size |
33 |
27 |
$813.86 |
| E0562 |
Humidifier heated used w pap |
14 |
13 |
$645.18 |
| A4452 |
Waterproof tape |
48 |
41 |
$484.88 |
| K0001 |
Standard wheelchair |
24 |
24 |
$335.68 |
| A7003 |
Nebulizer administration set |
110 |
108 |
$182.13 |
| A7015 |
Aerosol mask used w nebulize |
119 |
114 |
$132.02 |
| A7038 |
Pos airway pressure filter |
13 |
12 |
$74.92 |
| A4450 |
Non-waterproof tape |
39 |
32 |
$70.44 |
| A6402 |
Sterile gauze <= 16 sq in |
15 |
13 |
$59.73 |
| A4217 |
Sterile water/saline, 500 ml |
18 |
13 |
$0.00 |